Veillonella spondylodiscitis in a healthy 76-year-old lady

Abstract

Purpose: To report a case of Veillonella spondylodiscitis in a healthy 76-year-old lady.

Methods: A previously healthy 76-year-old lady presented with worsening axial back pain at the thoracolumbar junction, fever and loss of weight. Examination revealed deep tenderness over the thoracolumbar junction with painful and restricted spinal movements. The lower limb motor power, sensation and reflexes were normal.

Results: Radiographs of the lumbosacral spine showed evidence of spinal instability with lateral translation and loss of disc space at L1-L2. MRI scans revealed fluid intensity within the L1-L2 disc with infective debris elevating the posterior longitudinal ligament and narrowing the spinal canal. Both tissue and blood cultures were positive for the anaerobic organism, Veillonella. A staged anterior-posterior spinal surgery followed by an extended course of antibiotics resulted in the clinical improvement and normalisation of blood parameters. A review of the literature on Veillonella infections is also presented.

Conclusion: The aim of this report is to bring Veillonella spondylodiscitis to the attention of spinal surgeons and infectious disease specialists and discuss the management options.

Fig. 1-2

Anteroposterior and lateral radiographs of the lumbosacral spine showing lateral translation and loss of disc space and vertebral destruction at L1–L2 level

Fig. 3-4

T1 and T2 weighted sagittal MR images of the lumbosacral spine showing fluid in the L1–L2 disc with loss of definition of the adjacent end-plates and infective debris elevating the posterior longitudinal ligament and narrowing the spinal canal

Fig. 5-6

T1 and T2 weighted axial MR images of the lumbosacral spine showing narrowing of the spinal canal caused by infective debris at the L1–L2 level

Fig. 7-8

Sagittal and axial CT scan sections performed after the first stage of surgery showing the extent of the surgical decompression and the rib grafts in situ

Fig. 9-10

Post-operative radiographs (anteroposterior and lateral) showing a T11–L4 posterior instrumented spinal fusion with spinal realignment